Mental Health exam 1

b

1. J has been admitted to the psychiatric hospital for assessment and evaluation. What behavior might indicate that J has a mental illness? a. She is able to see the difference between the "as if" and the "for real." b. She describes her mood as consistently sad, discouraged, down in the dumps, hopeless. c. She responds to the rules, routines, and customs of any group to which she belongs. d. Within the limits set by her abilities, she can perform tasks she attempts.

c

11. Which of the principles of planning nursing intervention to meet client goals is violated in this scenario? Goal: Client will, with the aid of staff, remain safe while in the hospital. Interventions: Allow client to attend off unit programming unsupervised. Client can access all personal belongings. a. The interventions are not nursing focused. b. The interventions are not individualized. c. The interventions are not safe. d. The interventions are not relevant to the goal.

d

12. The nurse must plan interventions directed toward meeting the client goal: Client will remain safe during hospitalization with the assistance of staff. Which nursing intervention is related to this goal? a. Encourage patient to discuss relationship with family members. b. Assist client to identify three personal weaknesses. c. Observe client for therapeutic effects of psychotropic medication. d. Implement suicide precautions.

b

13. A nurse behavior that jeopardizes the boundaries of the nurse-client relationship is a. Focusing on the client's needs. b. Allowing the relationship to become social. c. Suspending judgment. d. Recognizing the need for supervision.

c

2. An outcome for S is that she will demonstrate mentally healthy behavior. Which behavior indicates the outcome is being met? a. She is aggressive in meeting her needs without considering the rights of others. b. She behaves without considering the consequences of her actions. c. She sees herself as approaching her ideals, and as capable of meeting demands. d. She passively allows others to assume responsibility for major areas of her life.

b

3. Strength of the multiaxial DSM-IV is that it: a. includes nursing as well as medical diagnoses b. assessments of several aspects of functioning are made c. it employs the framework of a specific theory d. plans for treatment and evaluation are included

c

31.The wife of a client who has delusions of infidelity asks the nurse if there are any circumstances under which the treatment team may violate the client's right to confidentiality. The specialist must reply that confidentiality may be violated a. under no circumstances b. when questions are asked by law enforcement officers c. if the client threatens the life of another person d. at the discretion of the psychiatrist

d

4. The nurse must assess the mental health or mental illness of several new clients at the mental health clinic. Some of the traits of mental health include: a. Accurate appraisal of reality b. Ability to work and be productive c. Ability to control one's own behavior d. All of the above

c

43. Which of the following is considered an obsession in OCD (obsessive compulsive disorder) a. hand washing b. ritualistic counting c. fear of germs d. excessive order

b

44. Which of the following is considered a side effect of the anti-anxiety (anxiolytic) medication ativan? a. Decreased tolerance b. Increased sedation c. Increased cognitive function d. All of the above

b

45. Which of the following anti-anxiety medications is considered non-addictive? a. valium b. buspirone c. klonopin d. xanax

b

5. B tells the nurse, "I'm a real freak. I'm a psychiatric patient, in and out of hospitals all the time. None of my friends or relatives is crazy like this." What reply would help B understand the prevalence of mental illness? a. "Comparing yourself with others has no real advantages." b. "Mental illness affects 80% of the adult population in any given year." c. "Nearly 50% of all people age 15 to 55 have had a psychiatric disorder at some time in their lives." d. Unfortunately, there are no answers to your question.

d

6. The nurse who interviews K notes she is profoundly depressed with thought of wanting to die. Took an unknown amount of pills yesterday. She has refused to do activities of daily living such as bathing. She also has not eaten for the past 5 days, according to her husband. The nurse will code her global assessment of functioning as a. 100 b. 50 c. 25 d. 10

b

7. Maslow offers a theory of human motivation that assumes patients have: a. Developmental tasks and psychosocial crisis b. a hierarchy of needs c. the process of schemata, assimilation and accommodation d. all of the above

a

8. Which statement allows the nurse to suspect that the developmental task of infancy, according to Erickson, was not successfully completed? a. "I'm afraid to allow anyone to really get to know me." b "I'm absolutely right, so don't bother saying more." c "I'm so ashamed because I didn't do it correctly in the first place." d "Andy and I are very close friends."

d

9. T, a 39-year-old businesswoman and single parent of three, is experiencing many feelings of inadequacy in her job and family situation since her 16-year-old daughter ran away several weeks ago. T seeks the help of a therapist specializing in cognitive therapy. The nurse psychotherapist using cognitive therapy will treat T by a. focusing on unconscious mental processes b. negatively reinforcing an undesirable behavior c. discussing ego states d. helping her identify and change faulty thinking

b This behavior is typical of a child around the age of 2 years whose developmental task is to develop autonomy. The distracters indicate the child's behavior is abnormal.

A 2-year-old child often displays negative behaviors. The parent says, "My child refuses toilet training and shouts 'No!' when given directions. What do you think is wrong?" Select the nurse's best reply. a. "The child needs firmer control. It is important to set limits now." b. "This is normal for your child's age. The child is striving for independence." c. "There may be developmental problems. Most children are toilet trained by age 2." d. "Some undesirable attitudes are developing. A child psychologist can help you develop a plan."

d The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.

A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which psychosocial crisis is evident? a. Trust versus mistrust b. Initiative versus guilt c. Industry versus inferiority d. Autonomy versus shame and doubt

b The anal stage occurs from age 1 to 3 years and has as its focus toilet training and learning to delay immediate gratification. The oral stage occurs between birth and 1 year. The phallic stage occurs between 3 and 5 years, and the genital stage occurs between age 13 and 20 years.

A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which stage of psychosexual development is evident? a. Oral b. Anal c. Phallic d. Genital

a The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother's wrath. The superego would oppose the impulsive behavior as "not nice." The preconscious is a level of awareness.

A 4-year-old grabs toys from siblings and says, "I want that now!" The siblings cry, and the child's parent becomes upset with the behavior. Using Freudian theory, the nurse can interpret this behavior as a product of impulses originating in the: a. id. b. ego. c. superego. d. preconscious.

a The patient sees self as needing multiple explanations of new tasks at work and allows the parents to make decisions, even though she is 40 years old. These behaviors indicate a poorly developed self-concept.

A 40-year-old who lives with parents and works at an unchallenging job says, "I'm as happy as anyone else, even though I don't socialize much outside of work. My work is routine, but when new things come up, my boss explains things a few times to make sure I catch on. At home, my parents make decisions for me, and I go along with their ideas." The nurse should identify interventions to improve this patient's: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior.

a

A client is noted to have a high level of non-goal-directed motor activity, running from chair to chair in the solarium. He is wide-eyed and seems terror-stricken. He cries, "They're coming! They're coming!" He neither follows staff direction nor responds to verbal efforts to calm him. A nursing diagnosis of high priority is a. Risk for injury b. Self-care deficit c. Disturbed energy field d. Impaired verbal communication

c

A client tells the nurse, "I don't think I'll ever get out of here." A therapeutic response would be a. Why do you feel that way? b. "Everyone feels that way sometimes." c. "You don't think you're making progress?" d. "Keep up the good work, and you certainly will."

d Cognitive theory suggests that thought processes are the basis of emotions and behavior. Changing faulty learning makes development of new adaptive behaviors possible. The distracters relate to psychoanalytic therapy, biological therapy, and aversion therapy.

A cognitive strategy the nurse could use to help a dependent patient would be: a. avoidance training. b. filling the patient's pill minder. c. interpreting the patient's dream content. d. examining the patient's fears related to being independent.

c Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Milieu therapy involves environmental factors.

A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. What type of therapy would the nurse suggest? a. Psychoanalysis b. Milieu therapy c. Systematic desensitization d. Short-term dynamic therapy

a An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs.

A new bill introduced in Congress would reduce funding for care of persons with mental illness. Groups of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice

d The admitting physician would use axis IV to record psychosocial and environmental problems pertinent to the patient's situation, providing another source of information for the nurse. Persistent questioning may cause the patient to withdraw. The other distracters demonstrate violation of the patient's privacy rights and are not an effective solution.

A newly admitted patient is uncommunicative about recent life events. The nurse suspects marital and economic problems, but the social worker's assessment is not yet available. Select the nurse's best action. a. Focus assessment questions on these two topics. b. Ask another patient who shares a room with this patient. c. Avoid seeking information on these topics at this time. d. Refer to axis IV of the DSM-IV-TR in the medical record.

d Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for "fight or flight." GABA is a mediator of anxiety level. A high concentration of histamine is associated with an inflammatory response. A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation.

A nurse assesses that a patient has fear as well as increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter? a. GABA b. Histamine c. Acetylcholine. d. Norepinephrine

d Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory. GABA affects anxiety rather than memory. Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory. Decreasing dopamine at receptor sites is associated with Parkinson's disease rather than improving memory.

A nurse could anticipate that treatment for a patient with memory difficulties might include medications designed to: a. inhibit GABA. b. increase dopamine activity. c. reduce neurotensin metabolism. d. prevent destruction of acetylcholine.

a The DSM-IV-TR gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic criteria for a psychiatric illness.

A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. To determine criteria used to establish this diagnosis, the nurse should consult which resource? a. Diagnostic and Statistical Manual of Mental Disorders b. A nursing diagnosis handbook c. A psychiatric nursing textbook d. A behavioral health reference manual

c The use of five axes requires assessment beyond diagnosis of a mental disorder and includes relevant medical conditions, psychosocial and environmental problems, and global assessment of functioning. The DSM-IV-TR does not include treatment plans or nursing diagnoses. It does not use specific biopsychosocial theories.

A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it: a. focuses on plans for treatment. b. includes nursing and medical diagnoses. c. classifies problems in multiple areas of functioning. d. uses the framework of a specific biopsychosocial theory.

d The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. The distracters apply to theories of cognitive, behavioral, and biological therapy.

A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on: a. rewarding desired behaviors. b. changing the patient's self-concept. c. administering medications to relieve anxiety. d. enhancing the patient's interactions with others.

b Clinical epidemiology is a broad field that addresses what happens to people with illnesses seen by providers of clinical care. This study is concerned with the effectiveness of various interventions. Prevalence refers to numbers of new cases. Descriptive epidemiology provides estimates of the rates of disorders in a general population and its subgroups. Experimental epidemiology tests presumed assumptions between a risk factor and a disorder.

A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Prevalence b. Clinical epidemiology c. Descriptive epidemiology d. Experimental epidemiology

d Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption. One exemplifies generativity; the other embodies self-absorption. This developmental crisis would show a contrast between relating to others in a trusting fashion or being suspicious and lacking trust. Failure to negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviors that would be contrasted would be emotional isolation and the ability to love and commit oneself.

A nurse listens to a group of recent retirees. One says, "I volunteer with Meals on Wheels, coach teen sports, and do church visitation." Another laughs and says, "I'm too busy taking care of myself to volunteer to help others." Which developmental task do these statements contrast? a. Trust and mistrust b. Intimacy and isolation c. Industry and inferiority d. Generativity and self-absorption

d The prevalence for Alzheimer's disease is 10% for persons older than 65 and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. It is important for the nurse to provide information rather than probe the reason for the person's question.

A nurse participating in a community health fair is asked, "What is the most prevalent mental disorder in the United States?" Select the nurse's best response. a. Schizophrenia b. "Why do you ask?" c. Bipolar disorder d. Alzheimer's disease

d The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options are incorrect because each represents a negative feeling.

A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt b. Anxiety c. Humility d. Self-esteem

a The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning.

A nurse uses Maslow's hierarchy of needs to plan care for a patient with mental illness. Which problem will receive priority? The patient: a. refuses to eat or bathe. b. reports feelings of alienation from family. c. is reluctant to participate in unit social activities. d. is unaware of medication action and side effects.

c The DSM-IV-TR details the diagnostic criteria for psychiatric clinical conditions. The other references are good resources but do not define the diagnostic criteria.

A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. The ICD-10 b. Nursing Outcomes Classification c. Diagnostic and Statistical Manual of Mental Disorders d. The ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice

d The patient asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The distracters either do not answer the patient's question or provide untrue, misleading information.

A patient asks, "What are neurotransmitters? The doctor said mine are imbalanced." Select the nurse's best response. a. "How do you feel about having imbalanced neurotransmitters?" b. "You must feel relieved to know that your problem has a physical basis." c. "Neurotransmitters are substances we eat daily that influence memory and mood." d. "Neurotransmitters are natural chemicals that pass messages between brain cells."

d Fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty.

A patient expresses the desire to be cared for by others and often behaves in a helpless fashion. The patient's needs relate to which stage of psychosexual development? a. Latency b. Phallic c. Anal d. Oral

c The situation describes psychodynamic psychotherapy. The distracters use other techniques.

A patient had psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method. a. Rational-emotive behavior therapy b. Cognitive-behavioral therapy c. Psychodynamic psychotherapy d. Operant conditioning

d The patient is unable to maintain personal hygiene, oral intake, or verbal communication. The patient is a danger to self because of not eating. The distracters represent higher levels of functioning.

A patient is depressed, mute, and motionless. According to family members, the patient has refused to bathe or eat for a week. The patient's global assessment of functioning score is: a. 100 b. 50 c. 25 d. 10

a The behaviors in the stem develop as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the opposites of these traits.

A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate? a. Oral b. Anal c. Phallic d. Genital

c These statements show severe self-doubt, indicating that the crisis of gaining control over the environment was not successfully met. Unsuccessful resolution of the crisis of initiative versus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versus mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of generativity versus self-absorption results in self-absorption that limits the ability to grow as a person.

A patient says, "I never know the answers," and "My opinion doesn't count." The nurse correctly assesses that this patient had difficulty resolving which psychosocial crisis? a. Initiative versus guilt b. Trust versus mistrust c. Autonomy versus shame and doubt d. Generativity versus self-absorption

b The symptoms describe mania, which is effectively treated by mood stabilizers such as lithium and selected anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugs from the other classifications listed are not effective in the treatment of mania.

A patient with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse begins care planning based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n): a. anticholinergic. b. mood stabilizer. c. psychostimulant. d. antidepressant.

a Milieu therapy is based on the idea that all members of the environment contribute to the planning and functioning of the setting. The distracters are individual therapies that do not fit the description.

A patient would benefit from therapy in which peers as well as staff have a voice in determining patient privileges and psychoeducational topics. Which approach would be best? a. Milieu therapy b. Cognitive therapy c. Short-term dynamic therapy d. Systematic desensitization

d The information given centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities.

A patient's relationships are intense and unstable. The patient initially idealizes the significant other and then devalues them, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships

d Interpersonal psychotherapy returned the patient to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy. Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the patient understand what is going on in his life.

A person says, "I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor and I'm OK now." Which type of therapy was used? a. Milieu therapy b. Psychoanalysis c. Behavior modification d. Interpersonal psychotherapy

c The structure of the therapeutic environment has as foci an accepting atmosphere and provision of opportunities for practicing interpersonal skills. Both constructs are directly attributable to Sullivan's theory of interpersonal relationships. Sullivan's interpersonal theory did not specifically consider use of restraint or seclusion. Assessment based on developmental level is more the result of Erikson's theories. Sequencing nursing actions based on patient priority needs is related to Maslow's hierarchy of needs.

A psychiatric technician says, "Common sense is the most important part of working with people who have mental illness. Theories are just something to fill up textbooks." The nurse wants to educate the technician by identifying which common use of Sullivan's theory? a. The method nurses use to determine the best sequence for nursing actions b. The ongoing use of restraint and seclusion as behavior-management tools c. The structure of the therapeutic milieu of most behavioral health units d. Assessment tools based on age-appropriate versus arrested behaviors

c Positive or negative feelings of the patient toward the therapist indicate transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters are more related to biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common "homework" assignment used in cognitive therapy.

A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with psychoanalytic psychotherapy? a. Identifying the patient's strengths and assets b. Praising the patient for describing feelings of isolation c. Focusing on feelings developed by the patient toward the therapist d. Providing psychoeducation and emphasizing medication adherence

d Cognitive therapy emphasizes the importance of changing erroneous ways people think about themselves. Once faulty thinking is changed, the individual's behavior changes. The distracters describe a psychoanalytic approach and behavior modification.

A single parent who is employed full time complains of feelings of inadequacy related to work and family. The parent seeks help from a therapist who specializes in cognitive behavioral therapy. The therapist will treat the parent by: a. discussing ego states the parent experiences. b. negatively reinforcing undesirable behaviors. c. promoting assertive behavior at home and work. d. helping the parent identify and change faulty thinking.

b Sullivan believed that the nurse's role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan's theory. The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The other distracters relate to Maslow and behavioral theory.

A student nurse says, "I don't need to interact with my patients. I learn what I need to know by observation." An instructor can best interpret the nursing implications of Sullivan's theory to this student by responding: a. "Interactions are required in order to help you develop therapeutic communication skills." b. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills." c. "Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions." d. "It is important to note patients' behavioral changes, because these signify adjustments in personality."

d Sullivan's theory explains that security operations are interpersonal relationship activities designed to relieve anxiety. Because they are interpersonal, they are observable. Defense mechanisms are unconscious and automatic. Repression is entirely intrapsychic, but other mechanisms result in observable behaviors. Frequent, continued use of many defense mechanisms often results in reality distortion and interference with healthy adjustment and emotional development. Occasional use of defense mechanisms is normal and does not markedly interfere with development. Security operations are ego centered.

Although ego defense mechanisms and security operations are unconsciously determined and designed to relieve anxiety, the major difference is: a. defense mechanisms are intrapsychic and not observable. b. defense mechanisms cause arrested personal development. c. security operations are masterminded by the id and superego. d. security operations address interpersonal relationship activities.

d Caring evidences empathetic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The distracters give examples of statements that demonstrate advocacy or giving advice.

An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? "My nurse: a. always asks me which type of juice I want to help me swallow my medication." b. explained my treatment plan to me and asked for my ideas about how to make it better." c. told me that if I take all the medicines the doctor prescribes, then I will get discharged soon." d. spends time listening to me talk about my problems. That helps me feel like I'm not alone."

b

As L converses with the nurse, she states, "I dreamed I was stoned. When I woke up, I was feeling emotionally drained as though I hadn't rested well." If the nurse needs clarification of "stoned," it would be appropriate to say, a. "It sounds as though you were quite uncomfortable with the content of your dream." b. "Can you give me an example of what you mean by stoned?" c. "I understand what you're saying. Bad dreams leave me feeling tired, too." d. "So, all in all, you feel as though you had a rather poor night's sleep?"

c

As Nurse V considers her relationship with K, a client, at what point in the nurse-client relationship should she plan to first address the issue of termination? a. in the working phase b. in the termination phase c. in the orientation phase d. when the client initially brings up the topic

a The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material that relates to the patient problem.

Consider a therapist's statement: "The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation." Which perspective is evident in the speaker? a. Theory of interpersonal relationships b. Classical conditioning theory c. Psychosexual theory d. Behaviorism theory

d

During the first interview with a restless young man, the nurse notices that he does not make eye contact throughout most of the interview. It can correctly be assumed that a. he is not to be trusted in what he says because he is evasive b. he is really feeling sad and can't look the nurse in the eye c. he is shy and the nurse must move slowly d. more data is needed to draw a conclusion

d

L is experiencing considerable stress. She is in a work environment in which her boss treats her "like a doormat." She states he thinks nothing of demanding that she stay overtime and work on Saturdays whenever he is "in the mood to work." A healthy coping strategy the nurse might suggest for L is a. resigning the position b. starting individual short term therapy c. relying on the support of her family d. employing assertiveness techniques

c Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and reinforce speech through positive reinforcement.

Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? a. Encourage the child to observe others talking. b. Include the child in small group activities. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques.

c

S is a newly admitted acutely psychotic client. She is a private client of the chief of staff and a private-pay client. To whom does the psychiatric nurse caring for S owe the duty of care? a. Physician b. Health care agency c. Client d. Profession

d The medical diagnosis is concerned with the patient's disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient's response to stress and possible caring interventions. Both tools consider culture. The DSM-IV-TR is multiaxial. Nursing diagnoses also consider potential problems.

Select the best response for the nurse who receives a query from another mental health professional seeking to understand the difference between a DSM-IV-TR diagnosis and a nursing diagnosis. a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis takes culture into account." c. "The DSM-IV-TR diagnosis is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems." d. "The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing."

a

T states that before taking an examination he feels a heightened sense of awareness and a sense of restlessness. What nursing intervention would be most suitable for assisting T? a. Explain his symptoms as resulting from mild anxiety and discuss the helpful aspects of mild anxiety. b. Advise T to discuss his experience with a physician or psychologist. c. Offer to obtain an order for an anxiolytic that T can take when necessary. d. Listen without comment.

d The DSM-IV-TR classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a "schizophrenic" or "alcoholic," for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.

The Diagnostic and Statistical Manual of Mental Disorders classifies: a. deviant behaviors. b. people with mental disorders. c. present disability or distress. d. mental disorders people have.

d

The nurse caring for an angry manipulative client finds himself feeling angry with the client. The nurse should initially: a. refuse to care for the patient b. let the client know how he feels c. tell the nurse manager to assign the client to another nurse d. deal with his feelings in a supervisory session

d Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one part of biological factors. Empathy does not address increasing the spouse's level of knowledge about the cause of the disorder. The other distracters are not established facts.

The spouse of a patient with schizophrenia says, "I don't understand how nurturing or toilet training in childhood has anything to do with this incredibly disabling illness." Which response by the nurse will best help the spouse understand this disorder? a. "This illness is the result of genetic factors." b. "Psychological stress is at the root of most mental disorders." c. "It must be frustrating for you that your spouse is sick so much of the time." d. "New findings show that this condition more likely has biological rather than psychological origins."

b If the reuptake of a substance is inhibited, it accumulates in the synaptic gap and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake.

The therapeutic action of neurotransmitter inhibitors that block reuptake cause: a. decreased concentration of the neurotransmitter in the central nervous system. b. increased concentration of neurotransmitter in the synaptic gap. c. destruction of receptor sites. d. limbic system stimulation.

b The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering is as real as physical.

Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, "Why would you want to be a psychiatric nurse? The only thing they do is talk. You'll lose all your skills." Select the best response. a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients' problems." b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations." c. "I think I will be good in the mental health field. I did not like clinical rotations in school, so I do not want to continue them after I graduate." d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me."

c

Two staff nurses were considered for promotion. The promotion was announced via a memo on the unit bulletin board. The nurse who was not promoted told another friend, "I knew I'd never get the job. The hospital administrator hates me." If she actually believes this of the administrator, who, in reality, knows little of her, she is demonstrating a. Compensation b. Reaction formation c. Projection d. Denial

d

W has a mass in the left upper lobe of his lung. He is scheduled to undergo a biopsy. When the nurse explains the procedure to him, he seems to have difficulty grasping what she is saying and asks questions such as, "What do you mean I'm going to have surgery? What are they going to do?" His voice is tremulous. His respirations are noticeably rapid at 28 breaths per minute, and his pulse is 110 beats per minute. W can be assessed as having a cognitive problem called a. Rationalization b. Conversion c. Introjection d. selective inattention

c

W is having a series of diagnostic tests. He insists there is nothing wrong with him except a chest cold that he can't "shake off." His wife says he smokes and coughs a lot, has lost 15 pounds, and is easily fatigued. What defense mechanism is W using? a. Regression b. Displacement c. Denial d. Projection

c

What behavior on the part of Nurse G will produce the evaluation that termination of the therapeutic nurse-client relationship with P, a client, has been handled successfully? a. He gives P his personal telephone number and permission to call after her discharge. b. He avoids upsetting P by gradually focusing on other clients beginning 1 week prior to her discharge. c. He summarizes with P the changes that have happened during their time together and evaluates goal attainment. d. He offers to meet P for coffee and conversation three times a week for 2 weeks after her discharge.

a

What is the legal significance of the nurse's action when a client verbally refuses his medication and the nurse gives it over his objection? a. The nurse can be charged with battery. b. The nurse can be charged with negligence. c. The nurse can be charged with malpractice. d. No charges can be brought against the nurse.

a A simple way of showing respect is to address the patient by title and surname rather than assume the patient would wish to be called by the first name. The distracters violate confidentiality and autonomy or exemplify beneficence and fidelity.

Which action by a psychiatric nurse best supports the right of patients to be treated with dignity and respect? a. Consistently addresses patients by title and surname b. Strongly encourages a patient to participate in the unit milieu c. Discusses a patient's condition with the health care provider in the elevator d. Informs a treatment team that a patient is too drowsy to participate in care planning

d A nurse who understands that a patient's symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements.

Which belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental disorders reflect a person's cultural patterns.

b Stigma refers to stereotypical, negative beliefs. With respect to mental health and mental illness, stigma often leads to discrimination and uncaring attitudes. Mental illness has multiple causes, including stress, changes in brain structure or function, and genetic transmission.

Which comment most clearly shows a speaker views mental illness with stigma? a. "Some mental illnesses are inherited." b. "Most people with mental illness are unmotivated." c. "Severe environmental stress sometimes causes mental illness." d. "Some mental illnesses are brain disorders resulting from changes in how impulses are transmitted."

d The DSM-IV-TR profiles psychiatric diagnoses on five axes. Each axis defines a specific aspect of the diagnosis. Axis I identifies major clinical disorders. Axis II details personality and developmental disorders. Axis III identifies general medical conditions. Axis IV details psychosocial and environmental problems. Axis V rates the Global Assessment of Functioning.

Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting? a. I Acute renal failure II 75 III Bipolar disorder I, mixed IV Loss of disability benefits 2 months ago V None b. I Schizophrenia, paranoid type II Death of spouse last year III 60 IV None V Diabetes, type 2 c. I Polysubstance dependence II Narcissistic Personality Disorder III 90 IV Hyperlipidemia V Charges pending for assault d. I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80

b The correct response describes a mood alteration, which further reflects mental illness. The distracters describe mentally healthy behaviors.

Which finding best indicates that a patient has a mental illness? The patient: a. responds to rules, routines, and customs of a group. b. reports mood is consistently sad, discouraged, and hopeless. c. performs tasks attempted within the limits set by own abilities. d. is able to see the difference between the "as if" and the "for real."

a The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors.

Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved? A patient: a. sees self as approaching ideals and capable of meeting demands. b. seeks others to assume responsibility for major areas of own life. c. behaves without considering the consequences of personal actions. d. aggressively meets own needs without considering the rights of others.

a Autonomy is the right to self-determination, that is, to make one's own decisions. By exploring alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.

Which intervention by a psychiatric nurse best applies the ethical principle of autonomy? The nurse: a. explores alternative solutions with a patient, who than makes a choice. b. suggests that two patients who were fighting be restricted to the unit. c. intervenes when a self-mutilating patient attempts to harm self. d. stays with a patient demonstrating a high level of anxiety.

b

Which of the following is a description of the least restrictive alternative? a. Allowing the client to sign a 5 day release for discharge b. Offering the client a by mouth dose of medication instead of an injection c. Signing the petition, cert, and then another cert within 24 hours d. Placing the client in seclusion rather than restraints

b According to Erikson, the developmental task of infancy is the development of trust. The correct response is the only statement clearly showing lack of ability to trust others. Warm, close relationships suggest the developmental task of infancy was successfully completed; rigidity and self-absorption are reflected in the belief one is always right; and shame for past actions suggests failure to resolve the crisis of initiative versus guilt.

Which patient statement would lead the nurse to suspect unsuccessful completion of the developmental task of infancy? a. "I have very warm and close friendships." b. "I'm afraid to allow anyone to really get to know me." c. "I'm always absolutely right, so don't bother saying more." d. "I'm ashamed that I didn't do things correctly in the first place."

a

Which remark by the nurse would be an appropriate way to begin a therapeutic 1:1 session? a. "How shall we start today?" b. "Shall we talk about losing your privileges yesterday?" c. "What happened when your husband came to visit yesterday?" d. Tell me what led up to your hospitalization?

d

Which statement given below would be an example showing that Nurse G is using an open ended exploring question with her patient: a. "Do you think the medications are helping you?" b. "When were you born?" c. "Is there mental illness in your family?" d. "Tell me more about what was going on before your suicide attempt."

d

10. A therapy that grew out of the need to provide treatment for the posttraumatic stress disorder of returning veterans from WWII and Vietnam is: a. psychoanalysis b. milieu therapy c. systematic desensitization d. short-term dynamic therapy

a

For the client whose nursing diagnosis is powerlessness related to inability to control compulsive cleaning, the nurse recognizes that the client uses the cleaning to a. temporarily reduce anxiety b. gain a feeling of superiority c. receive praise from friends and family d. ensure the health of household members

d

T is an involuntary client on a psychiatric inpatient unit. He asks the nurse for a 5 day release for discharge. The best response for the nurse to make would be a. "I can't give you those forms without your doctor's knowledge." b. "Here is the number for the guardianship and advocacy commission. They will send you the forms." c. "Because you are an involuntary patient you are committed here for 30 days" d. "I will get you the form for you to fill out:

b Mood changes throughout the day may be related to circadian rhythm disturbances. Questions about sleep pattern are also relevant to circadian rhythms. The distracters apply to assessment for illusions and hallucinations, thought processes, and memory.

The nurse wants to assess a patient with major depression for disturbances in circadian rhythms. Select the best question for this aspect of the assessment. a. "Have you ever seen or heard things that others do not?" b. "What are your worst and best times of day?" c. "How would you describe your thinking?" d. "Do you think your memory is failing?"

a

The nurse wishes to teach an alternative way of coping to a client experiencing severe anxiety. The nurse will first need to a. use measures designed to lower the client's anxiety b. determine the mode of learning preferred by the client c. devise outcomes and construct a teaching plan d. place the client in seclusion until the anxiety subsides

c The superego contains the "thou shalts," or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality-testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort.

The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. The nurse supports the use of praise related to these behaviors. These qualities will likely be internalized and become part of the child's: a. id. b. ego. c. superego. d. preconscious.

a

A woman speaking of a rival for her husband's affection says in a gushy, syrupy voice, "She is a lovely person. I simply adore her." The woman may be employing a. Reaction formation b. Projection c. Denial d. Repression

c

In a session J cries as the nurse explores her relationship with her deceased mother. J sobs, "I shouldn't be blubbering like this." A statement by the nurse that will hinder communication is a. "The relationship with your mother is very painful for you." b. "I can see that you feel sad about this situation." c. "Why do you think you are feeling so upset?" d. "Crying is a way of expressing the hurt you're experiencing."

d

In a treatment team planning meeting a nurse states her concern about whether the staff is behaving ethically in using restraint to prevent one client from engaging in self-mutilative behavior when the care plan for another self-mutilating client calls for one-on-one supervision. The ethical principle that should govern the situation is a. Beneficence b. Autonomy c. Fidelity d. Justice

a The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill.

In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing God's voice speaking. b. is usually pessimistic but strives to meet personal goals. c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met.

a

K, a college student who usually gets As, has received a C on a difficult examination. He runs to the college health service. He is disorganized and only partially coherent. In order to reduce K's level of anxiety as quickly as possible, the nurse should first a. stay with him b. tell him that help will come c. question him to discover the events that led to his de-compensation d. tell him he will not be allowed to hurt anyone

b The parent's comment suggests feelings of guilt or inadequacy. The nurse's response should address these feelings as well as provide information. Patients and families need reassurance that the major mental disorders are biological in origin and are not the "fault" of parents. One distracter places the burden of having faulty genes on the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring.

The parent of a child with schizophrenia tearfully asks the nurse, "What could I have done differently to prevent this illness?" Select the nurse's best response. a. "Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance." b. "Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child's illness." c. "There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment." d. "Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting."

b Axis III indicates any relevant general medical conditions. Axis II refers to personality disorders and mental retardation. Together they constitute the classification of abnormal behavior diagnosed in the individual. Axis IV reports psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis. Axis V is the global assessment of functioning.

The psychiatric nurse addresses axis I of the DSM as the focus of treatment but must also consider physical health problems that may affect treatment. Which axis contains the desired information? a. II b. III c. IV d. V

c

14. P is being admitted to the psychiatric unit by Nurse G. P was brought to the emergency department after making a suicide attempt by taking an overdose of acetaminophen (Tylenol). P has been lavaged. She appears tense, withdrawn, and frightened. A therapeutic, empathetic response would be that Nurse G tells her: a. "I'd like to sit here with you". b. Tell me more about the suicidal attempt" c. It must be frightening to have just gone through all you have". d. What exactly was going on with you before you tried to hurt yourself".

d Prescriptive privileges are granted to masters-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning.

1. A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions? a. Conduct mental health assessments b. Establish therapeutic relationships c. Individualize nursing care plans d. Prescribe psychotropic medication

a Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations.

The nurse administers a medication that potentiates the action of GABA. Which effect would be expected? a. Reduced anxiety b. Improved memory c. More organized thinking d. Fewer sensory perceptual alterations